Introduction: It is estimated that 58.5 million US adults have arthritis. Osteoarthritis (OA) is the most common form. Current American Academy of Orthopedic Surgeons (AAOS) treatment recommendations include conservative management (education, rest, activity modification, physical therapy (PT)) and medications (acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), knee injections) with a recommendation against opioids and if conservative care is no longer helpful, knee replacement surgery is the next course of action.

Objective: To describe the current population and treatment trends in patients with symptomatic knee osteoarthritis.

Methods: A quality assurance project was completed to define the knee OA population in a private practice, and how their treatment aligns with AAOS guidelines and recommendations. Medical records were reviewed to identify patients and their age, gender, body mass index (BMI), numeric rating pain score (NRS) 0-10, where 0 means no pain and 10 is worst, and previous and present treatments. Treatments were evaluated against current non-arthroplasty and surgical AAOS Evidenced-based Clinical Treatment Guidelines.

Results: Two hundred ninety-two radiographically confirmed OA patients (35% male, 65% female) who are currently following up with the practice were analyzed. The average age and BMI were 69 and 32, respectively. Most commonly reported symptom was pain with an average score of 7. There were more patients (67%) with unilateral knee OA than bilateral knee OA. Over the counter medications (Acetaminophen, 25%, NSAIDs, i.e., Ibuprofen and Naproxen, 54%) were the most common treatment. Prescription NSAIDs (i.e., diclofenac, meloxicam) at 27% and opioids at less than 1% were used. Knee injections significantly delayed time to surgery since presentation (p<.05) with a mean of 411 days using injections (95% CI, 323 – 498) and visco-supplementation knee injections significantly delayed surgery compared to only corticosteroid knee injections (p<.05) with a mean of 579 days using visco-supplementation (95% CI, 400 – 757).

Discussion: Nearly half of patients had PT and 86% received knee injections (steroids, visco-supplementation). At the time of review, 28% underwent total knee arthroplasty. Knee injections were able to delay a patient’s time between presentation and surgery, with visco-supplementation delaying the time to a greater degree than corticosteroids.

Conclusion: Advanced age (greater than 65 years old) and obesity (BMI greater than 30) was common in this predominantly female population. Knee pain was the primary symptom at initial consultation. Rest, activity modification, oral medications, physical therapy, and knee injections were commonly used to treat OA. The results show conservative treatment options were exhausted prior to total knee arthroplasty.